Provider Demographics
NPI:1013439413
Name:REYES, CARLOS (DPT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 MARATHON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3755
Mailing Address - Country:US
Mailing Address - Phone:512-297-3851
Mailing Address - Fax:512-778-8860
Practice Address - Street 1:4111 MARATHON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3755
Practice Address - Country:US
Practice Address - Phone:512-297-3851
Practice Address - Fax:512-778-8860
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1299438225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist